PURPOSE: In developing countries, Hodgkin lymphoma (HL) affects the young population. In Ethiopia, nearly 70% of the population are < 35 years of age. Therefore, this study aimed to elucidate the age distribution, histopathologic patterns, clinical characteristics and treatment outcomes of HL in Ethiopia.MATERIALS AND METHODS: Data from clinical records of 133 consecutive patients with HL between 2014 and 2019 were reviewed and collected. Formalin-fixed paraffin-embedded tissue blocks of HL cases were collected and used for subtype classification.RESULTS: A total of 68.4% (91) of the patients were male; male-to-female ratio was 2.2:1. The median age was 22 years. The age distribution was 57.1% (76), 30.8% (41), and 2.3% (3) for the age groups (10-29), (30-59), and (60-69) years, respectively. Thirteen percent (12) were associated with HIV. The majority of the cases, 50.4% (67), were of the mixed-cellularity (MCCHL) subtypes and 30% (40) nodular-sclerosis (NSCCHL). Most HIV-associated cases (60%, 6) were of the MCHL subtype. The 4-year overall survival (OS) was 83.1%. The 4-year OS of early-stage patients was 100% and advanced-stage patients with low-risk (International Prognostic Score [IPS] ≤ 2) and high-risk (IPS ≥ 3) were 94.1% and 62.9%, respectively. All patients who received combined-therapy survived, whereas those who received doxorubicin, bleomycin, vinblastine, and dacarbazine only showed a 4-year OS rate of 77.9%.CONCLUSION: HL affects the youngest and most productive population in Ethiopia. The treatment outcome is favorable in both HIV-associated and non–HIV-associated HL. However, the study population was likely a highly selected group as the majority of the Ethiopian population do not have access to specialized care.

Epstein Barr Virus (EBV) has been recognized for its ability to transform B lymphocytes and for its association with different types of cancers including Hodgkin lymphoma. In addition, EBV may also modulate the microenvironment of HL. In this study, we aimed to investigate the prevalence of EBV among HL cases in Ethiopia and to assess the tissue cellular composition of EBV-related and EBV-unrelated cases. We constructed a tissue microarray (TMA) of 126 consecutive cases of classical HL (CHL) and nodular lymphocyte predominant HL (NLPHL) from a tertiary cancer centre, Tikur Anbessa Hospital, Addis Ababa, Ethiopia, and evaluated a panel of immunohistochemical markers. The quantification of immune cells was performed using HALO 2.3, a platform for image analysis from Indica Lab Inc. A total of 77/126 (61.1%) of HL cases expressed LMP1/EBER. Infiltration of CD8+, T-bet+ and FoxP3+ cells was higher in the microenvironment of EBV-related CHL, with P values of <0.001, <0.001 and <0.016, respectively. In contrast, the expression of PD1 was higher in the microenvironment of EBV-unrelated CHL cases (P < 0.001). Unlike in Western countries, the majority of HL cases in Ethiopia were associated with EBV. As FoxP3+ and PD1-expressing cells are thought to participate in down regulation of the immune response by different mechanisms, this finding highlights the previously unrecognized possibility that distinct immunosuppressive mechanisms may be ongoing within EBV positive and negative HL types. This may have important prognostic and therapeutic implications.

Epstein Barr Virus (EBV) has been recognized for its ability to transform B lymphocytes and for its association with different types of cancers including Hodgkin lymphoma. In addition, EBV may also modulate the microenvironment of HL. In this study, we aimed to investigate the prevalence of EBV among HL cases in Ethiopia and to assess the tissue cellular composition of EBV-related and EBV-unrelated cases. We constructed a tissue microarray (TMA) of 126 consecutive cases of classical HL (cHL) and nodular lymphocyte predominant HL (NLPHL) from a tertiary cancer centre, Tikur Anbessa Hospital, Addis Ababa, Ethiopia, and evaluated a panel of immunohistochemical markers. The quantification of immune cells was performed using HALO 2.3, a platform for image analysis from Indica Lab Inc. A total of 77/126 (61.1%) of HL cases expressed LMP1/EBER. Infiltration of CD8+, T-bet+ and FOXP3+ cells was higher in the microenvironment of EBV-related HL, with P values of <0.001, 0.006 and <0.001, respectively. In contrast, the expression of PD1 was higher in the microenvironment of EBV-unrelated HL cases (P = 0.001). Unlike in Western countries, the majority of HL cases in Ethiopia were associated with EBV. As FoxP3+ and PD1-expressing cells are thought to participate in down regulation of the immune response by different mechanisms, this finding highlights the previously unrecognized possibility that distinct immunosuppressive mechanisms may be ongoing within EBV positive and negative HL types. This may have important prognostic and therapeutic implications.

Review objectives: This scoping review aims to map the extent and nature of digital, biomarker, and multi-omics evidence on stress and cardiometabolic health trajectories among women in Sub-Saharan Africa, with particular attention to hypertension, glycemic and diabetes-related outcomes, adiposity and obesity, dyslipidemia, metabolic syndrome, pregnancy-related cardiometabolic conditions, and cardiovascular sequelae. In addition, the review will consider patterns of vulnerability and potential indicators of cardiometabolic resilience, defined broadly as the capacity to maintain or regain health despite exposure to stressors, where these are explicitly examined or can be inferred from study findings. Cardiometabolic markers are being captured alongside real-time physiological and behavioral data through digital tools and wearable technologies, providing opportunities for early detection, continuous monitoring, and risk stratification of cardiometabolic disorders (CMDs). The review will further assess the degree of integration across these domains, while identifying key research gaps and emerging methodological trends. Methods: The review will follow the Joanna Briggs Institute methodology for scoping reviews and will be reported in accordance with the PRISMA extension for Scoping Reviews. A comprehensive search will be conducted across electronic databases, including MEDLINE (PubMed), Embase, Scopus, Web of Science Core Collection, CINAHL, PsycINFO, Global Index Medicus, the Cochrane Library, and IEEE Xplore, as well as grey literature sources such as Google Scholar, World Health Organization Institutional Repository for Information Sharing, and the World Bank Open Knowledge Repository using pre-specified Boolean operators and keywords. Studies published in English from January 2015 to the date involving women aged 18 years and above in Sub-Saharan Africa that examine stress in relation to cardiometabolic outcomes using digital, biomarker, and/or multi-omics approaches will be included. Findings will be synthesized descriptively, with evidence stratified by cardiometabolic domain where feasible, including blood pressure and hypertension, glycemic and diabetes-related outcomes, adiposity and obesity, lipid-related outcomes, pregnancy-related cardiometabolic conditions, and broader cardiovascular outcomes.